D 2 | Orals | SPHC 2024

Room

1er étage - D130


Theme

Aspects of child and adolescent health


Chair

TBD.




Title

Sexual health among youth: the need for a sexual health and sexual rights approach to better understand, prevent and talk about sexual violence

Name
Lorraine Chok

Affiliation
Unisanté


Abstract

The World Health Organization defines sexual health as “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.  Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence”. Sexual health is then an integral part of health and well-being. Harmonious sexual development begins at an early age and gradually takes place throughout life. During adolescence, in addition to repositioning and searching for identity, and renegotiating relationships with themselves and others, young people test their limits, and learn to respect those of others. This phase of transition, learning and experimentation between childhood and adulthood (which can last until the age of 25 or even 30) can present certain challenges. Young people can be particularly vulnerable to sexual violence in the midst of a physical and psychosocial transition. In a 2018 study on sexual health and behavior among 24-26-year-olds young adults in Switzerland, 25% of females and 8% of males reported unwanted sexual experiences. Females were much more likely than males to have accepted sexual relations without really wanting (53% versus 23%). In addition, 16% of young females 3% of young males reported having been sexually abused or raped with a mean age under 15 for both sexes.

To achieve and maintain sexual health, it is important to promote healthy relationships among young people and sexual rights must be guaranteed for the entire population. It is therefore important to raise awareness of sexual rights among professionals and offer them tools to support the sexual development of children and young people.

This workshop will be divided into two main parts:

1) Sexual rights

2) Definitions and data on four topics:

a) Consent and laws

b) Unwanted sexual experiences – “grey rape”

c) Street harassment

d) Online sexual violence – cybersexism

2) Examples of campaigns and tools to promote sexual health

Discussions with participants will focus on specific tools (e.g. opinions on promotion / prevention spots) and on two examples of situation of sexual behaviour of children, adolescents and adults.



Title
Machine Learning powered Patient Records Analysis for Injury Monitoring in Children and Adolescents

Name
Feer Sonja

Affiliation
Institut of Public Health, ZHAW


Abstract

Background:
Injuries to children and adolescents are common and are associated with individual suffering and costs for the healthcare system and society. The incidence of injuries among children in Switzerland has so far been insufficiently monitored. This study investigates the feasibility of utilizing machine learning (ML) methodology to automatically extract insights from electronic patient record data needed for monitoring and prevention purposes.

Method:
First, we assessed the utility of text data from electronic emergency patient records for injury monitoring and prevention. Text quality and desired information content were assessed in a sample of 100 electronic case histories. ML experts investigated data regarding ML requirements.

Second, we are developing an ML approach for accident-relevant information extraction based on 24’000 electronic case histories of children treated for injuries between 2018 and 2022 at the University Children’s Hospital Zurich emergency department. The development of the ML approach requires manual annotation based on an internationally used code-tree, followed by a design and implementation of the ML methods needed for automatic extraction of the information for injury monitoring. The methods’ performance will be evaluated on randomly selected case histories, not included in the initial method development.

Finally, generalizability of the ML approach will be tested on patient records from an emergency department of another Children’s Hospital.

Results:
Qualitative assessment of the sample showed that the desired information on injuries (i.e., type of injury, mechanism and products involved) is contained in the electronic emergency patient records and case histories. Most of the patients had minor injuries. The more severe the injury, the more detailed the information. Electronic case history data are suitable for application of ML approaches.

Lessons learned and the challenges faced during the development process of the ML approach, along with initial findings on injuries in children and adolescents, will be available by August 2024.

Conclusion and recommendations:
Extraction of injury information from electronic patient record by means of ML may provide valuable data for injury prevention, so far missing. The current study is monocentric. In future, the SwissPedHealth dataset represents a potentially promising national database for applying the ML approach and monitoring pediatric injuries.



Title
Long-term Mortality Effects of the 1918/19 Pandemic Birth Cohort in Switzerland

Name
Katarina Matthes 

Affiliation
Institute of Evolutionary Medicine, University of Zurich


Abstract

Infectious diseases, especially pandemics, can have lasting health consequences beyond the immediate effects. Several studies have shown that exposure to the 1918/19 pandemic or other unfavorable in-utero conditions are associated with an increased risk of enduring adverse effects on health, mortality, and socioeconomic status in adulthood. Moreover, adverse post-pandemic outcomes are often not associated with the pandemic because it may have already faded into the background decades ago. This emphasizes the importance of post-pandemic monitoring that goes beyond those directly affected. In Switzerland, it has already been shown, that the birth cohort of 1918/19 (experiencing in-utero exposure during the 'Spanish flu') exhibited a decreased life expectancy from the age of 50 when compared to adjacent birth cohorts. However, the causes of death that contribute to the increased mortality risk experienced by the 1918/19 birth cohort have not yet been investigated. The factors for the increased risk of death and the specific causes of death that are responsible for this are still unknown. It is also unclear whether these causes of death vary depending on the trimester of pregnancy in which the in-utero exposure took place.

This study aims to identify the causes of death among the 1918/19 birth cohort in Switzerland and to compare their risk of dying from these causes with that of the surrounding birth cohorts. Individual data from the cause of death statistics from the Swiss Federal Statistical Office for the years 1969 - 2022 are used to investigate whether the causes of death in the 1918/19 birth cohort differ from adjacent birth cohorts and whether these causes are influenced by the trimester of in-utero exposure.

The risk of dying from cancer, cardiovascular diseases, or diabetes is increased for the 1919 birth cohort for females and males compared to surrounding birth cohorts. Furthermore, it is expected that trimester of exposure will play a crucial role in the later causes of death.
Prospectively, it remains speculative to predict whether the COVID-19 pandemic will influence the 2020/21 birth cohorts in the decades to come. However, post-pandemic surveillance of neonatal health should be an important component of public health policy, in the post-COVID-19 era and also in future pandemics. This study aims to contribute to a deeper understanding of the long-term consequences associated with in-utero exposure to infectious diseases.



Title
LLTAGSHERAUSFORDERUNGEN VON ELTERN MIT TIEFEREM SOZIOÖKONOMISCHEN STATUS

Name
Paz Castro Raquel

Affiliation
Marie Meierhofer Institut für das Kind (MMI)


Abstract

Ausgangslage:
Digitale Medien prägen den Alltag von Familien mit Kleinkindern. In vielen Fällen stellen digitale Medien für die Eltern sowohl hilfreiche, berufliche Werkzeuge, wie auch eine Ressource zur Bewältigung des stressreichen Familienalltags dar. Aktuelle Studien zeigen, dass die Auswirkungen der kindlichen und elterlichen Mediennutzung in Bezug auf die kindliche Entwicklung stark variieren können, je nachdem in welchem Kontext das Kind aufwächst und welche Inhalte es nutzt. Ein kontextueller Faktor, welcher häufig diskutiert wird, ist der sozio-ökonomische Status (SES). Tieferer SES geht mit einer höheren Bildschirmzeit von Kleinkindern einher und mit ungünstigeren Entwicklungsoutcomes. Doch wenig ist über die Veränderungsbereitschaft von Eltern mit tieferem SES im Hinblick auf die Mediennutzung bekannt und über die Herausforderungen, die sie im Alltagsumgang mit digitalen Medien erleben. 

Methode:
Im März 24 wurden 107 Elternteile mit mind. einem Kleinkind (<5-jährig) in Bezug auf die Herausforderungen rund um den Alltagsumgang mit digitalen Medien befragt. Zur Erreichung von Personen mit tieferem SES wurde ein aufsuchender Ansatz in Familienzentren und Kinderarztpraxen in Gebieten mit geographisch tieferen SES in der Region Zürich umgesetzt.

Resultate:
Die Mehrheit der Befragten war weiblich (82, 76.6%) und im Schnitt 35.3 (SD: 4.7) Jahre alt. Über Dreiviertel (82, 76.6%) hatten einen Migrationshintergrund und 56.6% (60) wiesen max. einen Sek II Abschluss aus. Im Schnitt lag ihre subjektive Einschätzung des SES bei 6.1 (SD: 1.5; Skala 1-10). Eltern mit tieferem SES nannten v.a. folgende Herausforderungen: Medienexposition über Geschwisterkinder, Umsetzung von Regeln, Ungleiche Einstellungen im Umfeld und Bewältigung der Hausarbeit ohne digitale Medien. SES und Selbstwirksamkeitserwartung korrelierten positiv (r = .218, p = .015), während SES und totale Bildschirmzeit pro Tag (�= -.147, p = .028) negativ korrelierten. SES korrelierte mit der Veränderungsbereitschaft in Bezug auf die eigene (�= .256, p = .012), nicht jedoch auf die kindliche Mediennutzung (tiefer vs. hoher SES: 25.7% vs. 21.3%).

Diskussion:
Der aufsuchende Ansatz war erfolgreich, um die Zielgruppe zu erreichen. Der SES steht in keinem Zusammenhang zur Veränderungsbereitschaft der kindlichen Mediennutzung, jedoch zur Selbstwirksamkeitserwartung der Eltern. Darauf und auf den relevanten Alltagsherausforderungen, wird die Intervention Kinder und Digitale Medien (iKiDiM) des MMI aufbauen.




Title

Facilitators and Barriers of Maternal and Infant Healthcare Access for Undocumented Migrants: A Systematic Review

Name
Montagnoli Caterina

Affiliation
University of Basel


Abstract

Background:
Adequate access to healthcare in the first 1000 days of life is concurrent with lifelong well-being and should be guaranteed regardless of nationality, legal status, and social conditions. By exploring how migration status affects the social determinants of health, this review provides a nuanced understanding of the barriers and facilitators encountered by undocumented migrant women and their infants in the first 1000 days of life when accessing healthcare.

Methods:
Following the PRISMA guidelines for systematic reviews and the registration of the protocol on PROSPERO (registration number: CRD42022328220), a literature search in PubMed, Embase, CINAHL, PsycInfo, and Scopus from 2000 to 2022 was performed.

Results:
Of 1295 initial results, 45 studies met the inclusion criteria. Identified barriers of healthcare access in the first 1000 days include (1) legal barriers, such as the criminalization of migrants or the complexity of administrative procedures, and (2) socio-cultural barriers, such as inadequate health literacy and financial challenges. Additionally, ethical concerns as barriers of healthcare access were also mapped from the included papers. Facilitators that improved healthcare accessibility include (1) legal facilitators, like dedicated healthcare clinics, and (2) socio-cultural facilitators, such as language support and healthier lifestyle habits. 

Conclusion:
Considering the health consequences on future generations, the economic implications, and the vulnerability of pregnant (migrant) women, these findings offer examples of facilitators that could be put into place to move towards universal health coverage. Achieving this requires a holistic multidisciplinary approach that shifts from exclusion and criminalization to support and compassion.